Establishing standards of practice for endoscopic sleeve gastroplasty: a global expert consensus using a modified Delphi method.

Overview

BACKGROUND AND AIMS: Endoscopic sleeve gastroplasty (ESG) is a minimally invasive treatment for obesity with established efficacy and safety. However, procedural techniques vary. In this study, our aim was to develop a standardized ESG approach. METHODS: A modified Delphi method was used to define key ESG steps. Global ESG experts (≥300 procedures) participated in 3 survey rounds. Items with ≥70% agreement were included, and those with <70% consensus were discussed. Only items with unanimous final agreement were retained. RESULTS: Six experts participated. The final list of key ESG steps included 27 statements: 6 on cognitive skills (100% consensus) and 21 on technical skills (all with high consensus). The latter covered diagnostic endoscopy and presuturing steps (97%), fundamental suturing steps (100%), and suture patterns (97%). Key procedural elements with the highest consensus included starting at the incisura, using at least 6 sutures, and avoiding the fundus. CONCLUSIONS: This expert consensus provides step-by-step guidance for safe and effective performance of ESG.